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Ortho PANRE 2
Orthopedics
| Question | Answer |
|---|---|
| Acromion process Type I: | Flat, smooth acromion at clavicular joint; normal subacromial space |
| Acromion process Type II: | Hooked acromion; subacromial space mildly decreased |
| Acromion process Type III: | Hooked acromion with spur; subacromial space significantly decreased |
| Night pain: may indicate | Rotator cuff injury, Impingement, Frozen |
| Scapular winging/trauma = | Serratus or Trapezius dysfxn |
| Unable to externally rotate = | Posterior dislocation |
| Supra/infraspinatus wasting = | RCT or suprascapular n. palsy |
| Pain or “clunk” w/ motion = | Labral tear |
| Rotator cuff: tests for impingement | Neer; Hawkins (both passive) |
| Test of AC joint | crossover (passive) |
| Tests for biceps tendonitis | Speeds; Yergason (both active) |
| Tests for anterior shoulder instability | Sulcus; apprehension & relocation (both passive) |
| Tests for labral tears | Obrien; anterior slide; crank |
| Circulation tests | Adson; Allen; Roos |
| Shoulder imaging: Standard views: | AP and axillary |
| Imaging: Can get Y view if: | suspected dislocation or scapular fx (trauma) |
| Best imaging for RCT | CT arthrogram good, but MRI is better (invasive) |
| Posterior SC Dislocations: Concern | Can be life-threatening; immediate referral and CT |
| Posterior SC Dislocations: Mgmt | Closed reduction or surgical reduction |
| 95% of shoulder dislocations are: | Anterior Dislocations |
| Biceps Rupture: usually involves: | long head of biceps (short head rupture rare) |
| Avulsion of the antero-inferior glenoid labrum = | Bankart lesion |
| Compression fx of posterior humeral head = | Hill-Sachs lesion |
| Shoulder dislocation: xray & reduction maneuvers (3): | Rowe (opposite ear over head), Stimson (prone), Hippocratic (traction) |
| Most common cause of shoulder pain | Impingement |
| Single most sensitive and specific physical exam finding in rotator cuff tears | weakness with resisted external rotation and or abduction |
| Posterior fat pad on elbow x-ray = | Always pathologic |
| Posterior fat pad sign in adults may indicate: | radial head fx |
| Posterior fat pad sign in kids = | supracondylar fx |
| Radial Head Subluxation AKA | Nursemaids Elbow |
| Radial Head Subluxation = | Annular ligament entrapment |
| Distal Humerus Fx: use ____ Classification | Mehne & Matta |
| Most common elbow fracture in children | Supracondylar Fx |
| Radial Head Fx: Mgmt: Type I (non-displaced) | Posterior splint/sling for 3-5 days; Early ROM exercises |
| Radial Head Fx: Mgmt: Type II (displaced) | Tx as in Type I if < 30% head displaced (Otherwise: ORIF) |
| Radial Head Fx: Mgmt: Type III (comminuted) | Excision of frags or complete radial head |
| Radial Head Fx: Mgmt: Type IV (dislocated) | Same as III |
| Olecranon Fx: Check: | N/V function; Ulna n. |
| Gilula Arcs: articular surfaces of carpal bones s/b: | parallel, joint spaces similar width & parallel cortical margins |
| Gilula Arcs: any break in the lines or overlapping of normally parallel joint spaces suggestive of: | joint injury |
| Tinel Sign | Percuss over median n. carpal tunnel; tingling or pain in median n. distn = Pos |
| Phalen Test | Acute flexion of wrists for 60-90 sec => numbness & tingling over median n. distn |
| Scapholunate Dissociation: S/S | Wrist pain & instability; Letterman sign; Watson Test |
| Ulna Impaction Syndrome: leads to: | lunotriquetral ligament attrition |
| Kienbock Dz = | Lunatomalacia |
| Monteggia fx = | Ulna shaft fx; Proximal radius dislocation |
| Monteggia fx: tx | ORIF vs long arm cast for 6 weeks |
| Galeazzi fx = | Radial fracture; distal Ulna dislocation |
| Galeazzi fx: tx | ORIF vs long arm cast 6 weeks |
| Both Bone Forearm Fx: Non displaced, non-angulated fx: | may be put in long arm cast 6 wks |
| Smith Fx: MOA | Fall on back of hand; Hyperflexion injury; volar angulation of distal fragment |
| Smith Fx: minor angulation = | acceptable; short arm cast 4-6 wk |
| Smith Fx: significant angulation = | Reduction, CRPP, ORIF |
| Barton Fx = | Intra-articular fracture; displaced radial articular fragment |
| Barton Fx: tx | ORIF |
| Chauffeur Fx: MOA | Oblique fx through the base of the radial styloid |
| Chauffeur Fx: Tx | Long arm cast for 1 mo. followed by short arm cast for 2 wks |
| Torus Fracture = | Buckle fracture with intact periosteum |
| Scaphoid Fx: 1/3 will develop: | osteonecrosis |
| 90% of distal radial fractures are: | Colles Fx; FOOSH injury; dorsal angulation of distal fragment |
| Most common carpal fx = | Scaphoid Fx (2/2 FOOSH) |
| CMC Osteoarthritis: Compression test | moving CMC Joint w/ longitudinal load applied |
| CMC Osteoarthritis: Grind test | grab the metacarpal base & rotate thumb |
| Dupuytren Contracture: Rx | No conservative Rx; Surgery indicated for fixed contracture of more than 30 degree |
| Trigger Finger = | Stenosing Tenosynovitis |
| Trigger Finger: Injection: | At site of tenderness/ nodule; Marcaine/ Kenalog; 25 g needle into sheath, not tendon |
| Hand Lacerations: No Mans Land = | btw distal palmar crease & PIP joint crease |
| Septic Tenosynovitis = | Bacterial infection of a tendon & tendon sheath |
| Septic Tenosynovitis: Hx | puncture, bite, or tooth wound (fight bite); progressive swelling & pain over 24-48 hr; Kanavel Sx: |
| Kanavel Sx: | Fusiform swelling of finger; sig tenderness along course of tendon; marked pain on passive extension; flexed finger at rest |
| Septic Tenosynovitis: Etiology: | Staph, Strep, MRSA |
| Septic Tenosynovitis: Rx: | IV Abx, I&D if progressing; consider tetanus & rabies prophylaxis |
| Most common digital infection = | Infection: Paronychia |
| Infection: Paronychia = | Localized staph cellulitis in gutter along fingernail |
| Infection: Paronychia Rx: | Soaks, PO antibiotics; digital block & I&D when abscess is organized |
| Infection: Felon = | Abscess of pulp space of distal phalanx |
| Subungual Hematoma: Tx | Evacuate hematoma; trepanation (burr hole into nail); X-ray |
| Subungual Hematoma: If > 50% of nail is affected: | nail s/b removed & laceration sutured |
| Osteoarthritis: Heberdens nodes: | DIP joint |
| Osteoarthritis: Bouchards nodes: | PIP joint |
| Boutonniere Deformity = | Loss of central slip insertion on proximal dorsal middle phalanx |
| Boutonniere Deformity S/S | Flexion of PIP & hyperextension of DIP |
| Swan Neck Deformity = | Joint Synovitis secondary to RA |
| Swan Neck Deformity on physical exam: | Flexion of the DIP & hyperextension of the PIP |
| Skiers Thumb AKA: | Gamekeepers thumb |
| Skiers Thumb: Stener lesion = | Aponeurosis interposed between ligament |
| Bennet Fx = | Fx of thumb metacarpal base |
| Bennet Fx: Tx: Comminuted = | Rolando fx |
| Metacarpal Fx: 5th MC neck fx = | Boxers fx |
| Metacarpal Fx: MC Neck: Tx: with > 40 degree angulation or extension lag: | CRPP |
| Hook of Hamate Fx = | Direct impact from racquet, baseball bat |
| Mallet Finger = | Rupture of extensor tendon distal to DIP |
| Mallet Finger: PE: | Unable to actively extend DIP |
| Jersey Finger = | Forceful extension of DIP; FDP avulsion |
| Jersey Finger: S/S | Pt unable to flex DIP; most common to ring finger |
Created by:
Abarnard
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